Regional Anesthesia

  • Elliot J. Krane
  • Artee Gandhi
  • R. J. Ramamurthi

Abstract

This chapter identifi es the role of regional anesthesia in pediatric pain management, not only for postoperative pain control, but also as a diagnostic and therapeutic tool for chronic pain conditions. The pharmacology of commonly used local anesthetics and adjuvant medications is described with explanations of pediatric physiology, dosing regimens, and toxicity. Various types of nerve blocks with their anatomical descriptions and specifi c indications are outlined, with reference to regional anesthesia textbooks for further details. By reviewing this chapter, the primary care physician should be able to identify the indications for regional anesthesia, the medications employed, and their function in the management of pediatric pain conditions.

Key words

Pain child regional anesthesia nerve block local anesthetic 

References

  1. 1.
    Dalens BJ. Regional anesthesia in infants, children, and adolescents. Baltimore: Williams & Wilkins, 1995.Google Scholar
  2. 2.
    Ross AK, Eck JB, Tobias JD. Pediatric regional anesthesia: beyond the caudal. Anesth Analg 2000;91:16–26.CrossRefPubMedGoogle Scholar
  3. 3.
    Gunter JB. Benefit and risks of local anesthetics in infants and children. Paediatr Drugs 2002;4: 649–672.PubMedGoogle Scholar
  4. 4.
    Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the french-language society of pediatric anesthesiologists. Anesth Analg 1996;83:904–912.CrossRefPubMedGoogle Scholar
  5. 5.
    Yaster M. Pediatric Pain Management and Sedation Handbook. St. Louis: Mosby, 1997.Google Scholar
  6. 6.
    Naguib M, Magboul MM, Samarkandi AH, Attia M. Adverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf 1998;18: 221–250.CrossRefPubMedGoogle Scholar
  7. 7.
    Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr 1993;122:S14–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Hansen TG, Ilett KF, Lim SI, Reid C, Hackett LP, Bergesio R. Pharmacokinetics and clinical efficacy of long-term epidural ropivacaine infusion in children. Br J Anaesth 2000;85:347–353.PubMedGoogle Scholar
  9. 9.
    Ingelmo PM, Fumagalli R. Central blocks with levobupivacaine in children. Minerva Anestesiol 2005;71:339–345.PubMedGoogle Scholar
  10. 10.
    McCann ME, Sethna NF, Mazoit JX, et al. The pharma-cokinetics of epidural ropivacaine in infants and young children. Anesth Analg 2001;93:893–897.CrossRefPubMedGoogle Scholar
  11. 11.
    Kakiuchi Y, Kohda Y, Miyabe M, Momose Y. Effect of plasma alpha1-acid glycoprotein concentration on the accumulation of lidocaine metabolites during continuous epidural anesthesia in infants and children. Int J Clin Pharmacol and Therapeutics 1999;37:493–498.Google Scholar
  12. 12.
    Brown DL. Atlas of Regional Anesthesia, 3rd ed. Philadelphia: Saunders Elsevier, 2006.Google Scholar
  13. 13.
    Hadzic A, New York School of Regional Anesthesia. Textbook of Regional Anesthesia and Acute Pain Management. New York: McGraw-Hill Medical, 2007.Google Scholar
  14. 14.
    Jankovic D, Harrop-Griffiths W, Jankovic D. Regional Nerve Blocks and Infiltration Therapy: Textbook and Color Atlas, 3rd ed. Malden, Mass: Blackwell Publishing, 2004.Google Scholar
  15. 15.
    Meier G, Bèuttner J. Peripheral Regional Anesthesia: An Atlas of Anatomy and Techniques, 2nd ed. Stuttgart, New York: Thieme, 2007.Google Scholar
  16. 16.
    Mulroy MF. Regional Anesthesia: An Illustrated Procedural Guide, 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2002.Google Scholar
  17. 17.
    Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM. Repetitive occipital nerve blockade for cervicogenic headache: A double-blind randomized controlled clinical trial. Pain Pract 2006;6:278–284.CrossRefPubMedGoogle Scholar
  18. 18.
    Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM. Repetitive occipital nerve blockade for cervicogenic headache: Expanded case report of 47 adults. Pain Pract 2006;6:278–284.CrossRefPubMedGoogle Scholar
  19. 19.
    Suresh S, Voronov P. Head and neck blocks in children: An anatomical and procedural review. Paediatr Anaesth 2006;16:910–918.CrossRefPubMedGoogle Scholar
  20. 20.
    Cooper K, Kelley H, Carrithers J. Perceptions of side effects following axillary block used for outpatient surgery. Reg Anesth 1995;20:212–216.PubMedGoogle Scholar
  21. 21.
    Ecoffey C. Pediatric regional anesthesia — update. Curr Op Anaesth 2007;20:232–235.CrossRefGoogle Scholar
  22. 22.
    Matsota P, Livanios S, Marinopoulou E. Intercostal nerve block with bupivacaine for post-thoracotomy pain relief in children. Eur J Pediatr Surg 2001;11:219–222.CrossRefPubMedGoogle Scholar
  23. 23.
    Benzon HT. Essentials of Pain Medicine and Regional Anesthesia, 2nd ed. Philadelphia: Elsevier Churchill Livingstone, 2005.Google Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Elliot J. Krane
    • 1
  • Artee Gandhi
    • 2
  • R. J. Ramamurthi
    • 3
  1. 1.Pediatric Pain Management CenterStanford University School of Medicine,, Lucile Packard Children's Hospital at StanfordPalo Alto
  2. 2.Anesthesia and Pain ManagementSt. Joseph Medical CenterKansas City
  3. 3.Stanford University School of MedicinePalo Alto

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